The Association Between Platelet Transfusion and Acute Kidney Injury Following Fontan Surgery

Area of Science:

• Pediatric Cardiology
• Transfusion Medicine
• Nephrology

Background:

• The Fontan procedure is a complex surgery for single-ventricle congenital heart defects.
• Organ dysfunction, including acute kidney injury (AKI), is a known complication post-Fontan.
• The role of blood component transfusions in AKI development after Fontan is not fully elucidated.

Purpose of the Study:

• To investigate the association between blood component transfusions (red blood cells, plasma, platelets, cryoprecipitate) and the incidence of AKI in children after the Fontan procedure.
• To identify specific blood products that may contribute to AKI development.

Main Methods:

• Retrospective cohort study of 88 children undergoing the Fontan procedure between 2009 and 2016.
• Data collected included transfusion records and laboratory values to assess AKI using Kidney Disease Improving Global Outcomes criteria.
• Multivariable regression analysis was used to adjust for potential confounders.

Main Results:

• 41% of children developed stage 1 AKI, 23% stage 2 AKI, and 15% stage 3 AKI post-surgery.
• A significant proportion of children received red blood cell (58%), plasma (73%), and platelet (47%) transfusions.
• Each 1 mL/kg increase in platelet transfusion was independently associated with an increased risk of severe AKI (OR: 1.160, P=.041).

Conclusions:

• Platelet transfusion is an independent risk factor for severe postoperative AKI in children following the Fontan procedure.
• This finding highlights the need for careful risk-benefit assessment of platelet transfusions in this vulnerable population.
• Further research into transfusion strategies and alternatives may be warranted to mitigate AKI risk.